Overall health Treatment Reform: an Opportunity for Insurance Marketplace Participation in Sierra Leone’s Professional medical Treatment Process

Shaun H. Ruff

The socialized process of healthcare shipping and financing, a relic of the British colonial period, even now practiced in Sierra Leone has obviously unsuccessful and any initiatives at resuscitating it without having implementation of main structural and systemic reform will only serve to lengthen the inevitable.

All over the planet, complete state management and administration of industries, solutions, marketplaces and the usually means of generation are steadily becoming a relic of the earlier. This model as practiced in the Sierra Leone healthcare process has empirically been demonstrated to have served only to stifle innovation, advancement, productivity and top quality output with a resultant decrease in general dwelling and healthcare requirements of the citizenry. The latest state of the hospitals and well being facilities obviously highlights the systemic issues endemic in the whole govt owned, managed, financed and operated well being care process.

The continued procedure of these a decadent and dilapidated shipping and financing process, missing in even the principles of a contemporary healthcare infrastructure continues relegating Sierra Leone to the very bottom of the human advancement index.

The transformation thus of the health care healthcare shipping and financing system into a personal insurance or a national insurance based process offers possibilities not only for insurers to develop market place-based health care insurance plans and procedures but also serves to effectuate the Ministry of Overall health & Sanitation’s preferred plan aims, as espoused in the 2002 Nationwide Overall health Coverage Paper.

The two plan and regulatory officials, healthcare vendors, the insurance field and other stakeholders have to be engaged to effectuate implementation of elementary systemic reforms if the region is to avert an even better disaster.


Under the proposed privatization program, the Ministry of Overall health & Sanitation will be remodeled from possession and administration of hospitals, clinics, and employer of very last vacation resort for all medical professionals, nurses and ancillary healthcare vendors into a well being agency with only plan and regulatory features.

The intention will be for the well being agency to serve as a plan and regulatory check out doggy mandated with making certain that enough and top quality health care care is offered at the numerous personal hospitals, clinics and pharmacies that will inevitably be founded with the split-up of the latest govt owned services.

With the split-up and subsequent order or leases of these hospitals, clinics, well being facilities and other services, buyers and entrepreneurs in an work to notice greatest returns on investments, will economically be compelled to upgrade top quality and regular of care, introduce state of the art machines and technologies and engender a variety of market place forces levels of competition which will inure only to the betterment of well being consumers in the region.

A significantly desired infusion of cash into the well being care field by these a privatization program will clearly spur additional financial activities in ancillary industries, as the dynamic forces of privatization and market place system forces of demand and source will make certain levels of competition for the healthcare pie.

Divestiture of Federal government Possession:

The dismantling of the latest mammoth and very inefficient govt owned healthcare shipping and financing entity have to from a general public plan perspective be designed and restructured to make certain governmental possession and administration divestiture from hospitals and other well being care services.

Underneath these a scenario the government’s latest monumental but woefully mismanaged cash outlay for well being solutions will be substantially lessened as inefficiencies of corruption, salaries of vendors, infrastructure maintenance, costs of drugs and diagnostic equipments and other overhead operating costs will no for a longer time be recurrent expenditures from the nation’s depleting coffers.

A process based totally on a personal market place-based national well being insurance program with personal enterprise and market place levels of competition at its core seems the most rational reform plan route to make certain a long run audio, effective and lucrative well being care infrastructure.

 Overall health Insurance Ideas:

The cog which the proposed new process have to revolve close to is a nationwide community of economical well being insurance plans creatively designed to make certain a better pool participation of a the greater part of the inhabitants. In these a process well being insurance companies and provider organizations will be founded to market place numerous well being plans, with minimum amount solutions and premiums based on market place ailments. The accountability for checking compliance by the numerous plans would tumble beneath the ambit of both the Ministry of Overall health and Sanitation and the Sierra Leone Insurance Fee.

Multi-Payer Process:

A main plank in this proposed well being care shipping and financing privatization hinges on the enactment of well being insurance legislation giving for businesses to provide well being care for their workers and dependants as portion of a regular added benefits offer with concomitant tax incentives and governmental subsidies to make certain compliance. With these legislation the virtual no cost socialized health care care process, the costs of which have been borne exclusively by the govt will now be based on a multi-payer process in which govt, workers and businesses will all participate.

With the process as presently structured nevertheless, only the govt has a money fascination and stake and when other systems conflict with the financing of well being care, politicians have only been much too keen to sacrifice the well being of their citizens on he alter of their greed and own aggrandizement.

It is envisaged that well being insurance vendors will introduce concepts and plans, these as Overall health Upkeep Corporations (HMO) and Chosen Supplier Corporations (PPO), by way of alliances of well being vendors and insurance companies and marketed to businesses, labor unions, governmental ministries and businesses on an annual quality basis.

The levels of competition engendered by these well being organizations for the health care insurance pie will subsequently end result in aggressive fees, coverage, deductibles, co-payments and premiums to make well being care costs economical for all.

The Unemployed:

As unemployment and underemployment are perennial issues in the Sierra Leonean financial system, the provision of well being care added benefits to this group of the inhabitants have to continue being the accountability of govt. Professional medical solutions offered to this group of citizens in a personal enterprise environment have to be reimbursed by the govt on a negotiated and pre-identified price program or an insurance system founded in which govt negotiates with vendors and carriers for the provision of solutions.

As an illustration a fund founded by levying taxes on the personal well being care vendors, envisaged to arise with these privatization, could be instituted and utilized to pay for these indigent solutions.

Further, because the hospitals, health care clinics and other health care services will be operated as businesses, both for financial gain or as non-financial gain organizations, the market place forces of demand and source will definitely make certain that client top quality care, advancements in diagnostic technologies, skilled staff and a basic responsiveness to the c
alls for of the consumers will push the new market. The lethargic and inefficient ambiance witnessed at most govt hospitals nowadays with client support nearly non existent would be a philosophy of the earlier.

The financial viability of healthcare businesses will depend largely on the clientele they can attract and sustain using the higher than yardstick. Suppliers of lousy well being care plans and solutions will inevitably free business to competition as each individual 12 months contributors will have an prospect to adjust well being insurance plans.

Considering that a huge inhabitants of Sierra Leone resides in rural locations, the proposed privatization program will make certain the enlargement of well being care services into locations presently inadequately serviced. This program will make certain that clinics and physicians put up shop in each individual portion of the region in buy to tap into the healthcare solutions obtainable in these rural locations.

Problems to Insurance Organizations:

Coming up with an insurance process and program to cater to the wants of the rural inhabitants who frequently are self employed in farming and mining activities posses a problem to insurers in Sierra Leone, who in the earlier have been largely passive and unimaginative in plan design to meet up with the challenges and pitfalls confronting the nation’s socio-financial landscape.

Proactive and innovative underwriting of pitfalls have to be undertaking by underwriters, actuaries and promoting specialists to design, tailor and selling price well being insurance coverage to meet up with the assorted wants of the insuring general public. For illustration, the generation of pools by occupational groups could be a person strategy by which insured’s, engaged in similar trades could be encouraged to form co-operatives for purposes of getting well being insurance coverage at economical fees for themselves and dependants. Top quality payments by way of the pooling together of the co-operatives commodities can be an substitute payment strategy for the health care solutions. Overall health insurance companies could maybe build subsidiary or ancillary companies entirely for the managing of payments manufactured by hard cash crops.

The latest process beneath which almost all physicians and linked well being care vendors are employed by the govt when at the exact time owning personal procedures would be adjusted with a concomitant govt discounts on salaries, productivity and other fringe added benefits. As privatization can take above in the hospitals, medical professionals, nurses and other vendors will no for a longer time be on the government’s payroll but will instead be unbiased contractors with their very own procedures.


While a micro edition of the proposed reform has mushroomed in an advertisement hoc fashion above the a long time with some huge companies and businesses contracting with unique medical professionals and clinics for the provision of well being care to their workers and dependants, the form of systemic and structural overhaul desired to forestall a complete collapse of the process and prolong similar solutions to all could only be understood by a extensive method alongside lines of reforms proposed in this plan paper.

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